Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow most commonly caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. But several other repetitive activities can also put you at risk. Additionally, a single elbow overload can produce micro or macro tears in the muscle attachment at the elbow and mimic this condition.
Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse – repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.
Anatomy
Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. the bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.
Muscles, ligaments, and tendons hold the elbow joint together.
Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearms tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).
What can cause Tennis Elbow?
Overuse
Recent Studies show that the tennis elbow if often due to damage from a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps to stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.
The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.
Activities
Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle.
Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.
Age
Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.
Symptoms
The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of the symptoms, however in approximately 5% of cases the individual can pinpoint a single overload.
Common signs and symptoms of tennis elbow include:
- Pain or burning in the outer part of your elbow
- Weak grip strength
The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench or shaking hands. Your dominant arm is most often affected; however, both arms can be affected.
Doctor Examination
Your doctor will consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors and recreational sports participation.
Your doctor will talk to you about what activities cause symptoms and where on your arm the symptoms occur. Be sure to tell your doctor if you have ever injured your elbow. If you have a history of rheumatoid arthritis or nerve disease, tell your doctor.
During the examination, your doctor will use a variety of tests to pinpoint the diagnosis. For example, your doctor may ask you to try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, it tells your doctor that those muscles may not be healthy.
Tests
Your doctor may recommend additional tests to rule out other causes of your problem.
X-Rays
These may be taken to rule out arthritis or calcifications of the elbow.
Magnetic Resonance Imaging (MRI)
This is done to delineate the magnitude of the damage when considering surgery and help delineate the surgical plan.
Electromyography (EMG)
Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.
Nonsurgical Treatment
Approximately 80% to 95% of patients have success with nonsurgical treatment.
Nonsurgical treatment options for tennis elbow include:
Rest
The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks.
Non-steroidal anti-inflammatory medicines
Drugs like aspirin or ibuprofen reduce pain and swelling.
Equipment Check
If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversize racquet, changing to a smaller head may help prevent symptoms from recurring.
Physical Therapy
Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform an ultrasound, ice massage or muscle-stimulating techniques to improve muscle healing.
Brace
Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons. The brace itself may promote neovascularization and healing in some cases.
Steroid Injections
Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject your damaged muscle with a steroid to relieve your symptoms.
Extracorporeal Shock Wave Therapy
Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promote the body’s natural healing processes. Shock wave therapy is considered experimental by many doctors, but some sources show it can be effective.
Surgical Treatment
If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery.
Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to the bone.
The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs. talk with your doctor about the options. Discuss the results your doctor has had and any risks associated with each procedure.
Open Surgery
The most common approach to tennis elbow repair is open surgery. This involves making an incision over the elbow. A majority of these techniques simply release the tendon, they are effective approximately 65% of the time. More advanced techniques such as Jobe Cicchati elevate and repair the tendon to the bone with suture anchors. This is Dr. Levy’s preferred open technique. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed. After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 4-6 weeks after your surgery. Your doctor will tell you when you can return to athletic activity. This is usually 3 months after surgery.
Tenex FAST Procedure
This is a cutting edge minimally invasive method to identify and remove pain generating scar tissue from tendons in the elbow, knee, ankle, foot and shoulder which can occur due to various musculoskeletal conditions such as tennis elbow, golfer’s elbow, jumper’s knee, plantar fasciitis, swimmer’s shoulder, and Achilles tendonitis.
The procedure is performed under local anesthesia to numb the affected area. The microtip of the TX1 tissue removal system, the size of a toothpick, is inserted into the affected area under ultrasound guidance. The tip releases ultrasonic energy which breaks and emulsifies the scar tissue which is then aspirated. It takes about 15 minutes and the tiny opening is covered with an adhesive bandage with no sutures required.
You will be able to return to normal activities in approximately one month after the procedure. Tenex FAST procedure is the treatment of choice for tendon pain when compared to conventional treatment which involves rest, medication and physical therapy. Recovery from conventional treatment can take a few years and restrict your activities during this time. Tenex FAST is also safer when compared to open surgery through an incision.
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